Provider Demographics
NPI:1598956476
Name:LEWIS, ELIZABETH B
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CASTLE VALE RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2623
Mailing Address - Country:US
Mailing Address - Phone:803-260-1260
Mailing Address - Fax:
Practice Address - Street 1:1420 FURMAN DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-1422
Practice Address - Country:US
Practice Address - Phone:803-494-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist